**23. Conclusion**

What we can infer from these trials that CEA has a lower stroke rate than CAS but CAS has a lower MI rate than CEA. If mortality, stroke and MI are mingled together as a single end-point, then both strategies are equivalent on the long-term. Advancing age is strongly against selecting CAS as the initial choice of revascularization. The results of either technique are critically dependent on the skills of the performing physician. Restenosis after CAS may be slightly more than restenosis after CEA but the severe, clinically significant restenosis is uncommon. In patients with concomitant coronary and carotid disease, stenting may have an advantage over CEA.

There remains a need for more trials assessing the future roles of medical management, carotid stenting, and carotid endarterectomy. Future trials should be designed with the assumption that some patients will be best managed medically, some with medical therapy plus stenting, and some with medical therapy plus endarterectomy. These treatments are complementary and not competing. Varying treatment algorithms including more or less liberal use of each modality can be designed, patients randomly assigned to one of the algorithms, and their results compared.[48]
